Please Print-one per child
| Child _______________________________________________________ | |||
| LAST name | FIRST
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Child's address (plus zip code) |
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_____________________________________________________________ _____________________________________________________________
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| Age _________________________ | Grade ___________________ |
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Parent _______________________________________________________ |
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Parent's day phone ____________________________________________ |
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Changes due to (please circle)
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Divorce |
Death | Stepfamily | |
Date of Change _______________________________________________ |
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Attended Rainbows before? Y N |
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Please turn completed form in to Mrs. Bigham.